Although there are no quiet guards at the children’s hospital, it already looked complicated as it began last Monday. Doctors say the outside guard was told earlier in the day that he could only have seven beds for the next 24 hours, half of what is normally offered and a third of what is required. As expected, these places were soon filled with boys who were needed for pictures of a certain gravity. And after hours, there was no room in the intensive care room either, the beds began to occupy what is known as the “shock room”.
Desperate that they couldn’t respond to the demand more than the attention that was pouring in on them, some doctors at Ludovica Hospital reported the situation to the Ministry of Health, while others started a WhatsApp message thread to ask their colleagues not to keep sending them more patients that could were taken care of elsewhere. However, at the end of that day, boys with complex conditions and under the care of cardiology or neurosurgery had to be turned away because there was no more room financially.
“We’ve ended up normalizing the delay of ‘non-urgent’ patients.”
How did the children’s guard collapse? What happened last Monday in particular? The most accurate answer would be “nothing that hasn’t happened in months, and in some cases years. The growing shortage of specialists willing to practice pediatrics in the public sector (due to harsh working conditions and low pay), combined with the private care system, which today in most cases cannot contain, finally exploded at the main regional level children’s hospital.
ANGLE AND RELAXATION
“Monday was a disaster, but it was like that recently. We’ve had days when we’re running 24 hours a day with only two free beds, banking patients with ventilators on duty waiting to find a place for them. When the shift ends, you go home very angry and disappointed,” admits Karina Bandin, one of Ludovica’s shift supervisors, who notes that it is not uncommon for some of her colleagues to end the day crying because they have been heroes. dramas that take place away from offices, such as the need to send mothers home whose children demand attention that cannot be given to them.
“The progressive decline in human resources has increasingly affected the quality and quantity of care we can provide. While doctors already trained and with invaluable years of experience resign and leave with better job offers, residential quotas remain unfilled because young people do not want such a burden for salaries not exceeding 130,000 pesos per month,” he concludes. Zulma Fernandes, President of the Association of Hospital Professionals.
“All this has forced Ludovica, the main pediatric hospital of the state, to close the reception of some services or to significantly reduce the number of pathologies solved in time,” describes Fernandez. We cannot perform significant complementary studies on our patients, carriers of serious complex pathologies. And we’ve had to cut down on surgery times because we don’t have the staff.”
“We’ve had a lot of difficulties lately, especially with human resources, so we’ve had to reduce beds,” admits Daniela Sassetta, head of Ludovica’s intermediate therapy room. Although our room has a capacity of 17 beds, we are working with twelve people because the team has been reduced to three doctors and three nurses per shift.”
“Because we have highly trained specialists that are not available in many places, we receive patients from out of state, but many times we do not have the supplies or equipment to offer them the care they expect to find. To carry out certain studies, we have to ask permission from the hospital management, which in turn asks the cooperative to take financial responsibility. And if we succeed, we have to ask for a shift outside, get into an ambulance, take the patient to be analyzed and bring back to the hospital. So many people that we are in the room today is impossible for us,” explains the specialist.
Due to the lack of staff in the operating room, we are rotating for endoscopy with a delay of 3-4 months to children who should do it now,” says Viviana Bernedo, a gastroenterologist at the Endoscopy Department.
“There are about 1,200 delayed outpatient surgeries,” they say at the Ludovica Hospital Specialists’ Association, where they recognize that this problem has already led to the heads of surgical specialties asking for their intervention.
“The gradual decline in human resources is having an increasing impact on the quality and quantity of care we provide. While trained doctors are resigning, residency positions remain unfilled because young people don’t want that kind of burden for a $130,000-a-month salary.”
President of the Ludovica Hospital Professionals Association
Because of our habituation to delay, “we eventually naturalized to delay patients that are ‘not so urgent’, such as lower gastrointestinal bleeding. We have to tell the mothers of bleeding children that they have to keep waiting for an endoscopy because there is no room. In some cases, we hospitalize them for weeks, even months, and finally they come to the operating room in bad condition because it was not done when it should have been done,” says the pediatric gastroenterologist.
CALL FOR ATTENTION
“What’s happening is that being a very complex hospital, with unique specialties across the state, today we’re getting very low complex demand that shouldn’t be coming here,” explains Mariana Fabi, chief of pediatric rheumatology Dell Ludovica. : , the only service of its kind statewide, as it’s a specialty with only about sixty professionals nationwide.
“Ludovica has a human resource that requires no less than ten years of training. But to take advantage of it, we need to work in a hospital that supports high complexity, which implies interdisciplinary support from other specialized services. Instead, the cutback has led to some services having to limit admissions, and that applies to everyone. If I don’t have a place in palliative care, I can’t offer good rheumatological treatment to a patient who comes in pain,” the professional charts.
As Fabi explains, the lack of human resources is a problem that can be caused by many reasons, but one that stands out above all is the salary factor.
“The biggest obstacle is the salary. It takes four years to train as a pediatric specialist, with another four years for an additional specialty. It becomes very difficult to tempt a young doctor to do this when he sees that at the end of the road he is waiting for 130,000 pesos a month, on which he can barely survive.
The Association of Hospital Professionals also highlights the strong incidence of the salary factor, which has led to a gradual decline in human resources. But as an additional reason, they also point to the crisis in primary care. “Ludovica is a very complex hospital that today deals with a high demand for cases that can be handled outside of it.
“We are asking the authorities to review the first level of care, which is not working well. The saturation that we are experiencing in Ludovica should be an alarm not only to the Ministry of Health, but also to the government,” they say from the subject.
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